静脈性血栓塞栓症の治療について
Philip S Wells1, Melissa A Forgie2, Marc A Rodger3
1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada2Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada.
JAMA
|February 20, 2014
まとめ
静脈血栓塞栓症 (VTE) の治療には,主に抗凝固薬が含まれています. 新しい経口抗凝固剤は,すべてのVTE治療段階において,簡素化され,安全かつ有効な選択肢を提供しているが,個別のリスク評価が不可欠である.
科学分野:
- 心血管医学は,心臓血管医学である.
- 血液学 ヘマトロジ
- 薬理学 薬理学とは
背景:
- 静脈血栓塞栓症 (VTE),深静脈血栓症 (DVT) と肺栓塞症 (PE) を含む静脈血栓塞栓症 (VTE) は,蔓延し,潜在的に致命的な状態です.
- VTEの効果的な管理には,急性,長期,長期の異なる治療段階を理解する必要があります.
研究 の 目的:
- VTEの病因に関する現在の理解をレビューする.
- VTEの急性,長期,延長期のエビデンスに基づく治療戦略を概説する.
主な方法:
- コクランレビュー,メタ解析,ランダム化比較試験を含む包括的な文献検索.
- アメリカン・カレッジ・オブ・チェスト・フィジシャンズ (American College of Chest Physicians) のアンチトロンボティック・セラピーガイドラインと専門組織のガイドラインの相談.
- 費用対効果の研究と内部文献データベースのレビューを含める.
主要な成果:
- 急性DVTの門診管理は,低分子量ヘパリン (LMWH) または単体療法として使用できる新しい経口抗凝固剤で実現可能である.
- 急性PEは,重症度と予後に基づいて,外科医として管理することもできます; 血栓溶解とIVCフィルターは,特定の重症症例に予約されています.
- 標準的な治療期間は3ヶ月で,再発リスクと出血リスクに基づいて治療期間を延長する決定が行われます; 新しい経口抗凝固剤は,すべての治療段階において有望であることが示されています.
結論:
- 抗凝固薬は,VTE治療の礎石であり,介入は特定の徴候に限定されています.
- 様々な治療法があり,病因,リスク,利益,費用,患者の好みなどを考慮して,個別の治療法を策定する必要があります.
- 最適なVTE管理のための個々のリスク予測を精密にするためにさらなる研究が必要です.
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